Why a Patient’s Age is Often Important in Orthodontics

Just this week I saw several patients for an initial consult, and because of their age and facial structure, each had an entirely different chance of achieving an ideal outcome with braces or Invisalign (a healthy, functioning bite with optimal aesthetic results). One woman was in her 50’s, and she was wondering if she was too old to have her crowded teeth aligned. Because she had a balanced skeletal structure, I informed her that her crowded teeth could be treated to very ideal and beautiful outcome, and her age would have little influence on this outcome. Later that day, I was visited by a 20 year old young man who also desired to have his teeth aligned with braces. His lower jaw had grown disproportionately less compared to his upper jaw, resulting in an excess “overbite” (as orthodontists we call it “overjet”). Due to his skeletal structure, combined with the fact that at his age his jaw growth was relatively complete and in a stable position, I had to explain to him that the ideal age to treat his condition has passed. Yes, I could greatly improve his bite and appearance, but because of his age and jaw structure, the finished result would have to be a compromise if treated with orthodontics alone (he would require surgery to re-position his upper and lower jaws into an ideal position). The mother of this patient stated that she heard that he could have his teeth corrected after they had all come in, and unfortunately this led to him not having an exam at a younger age.

The two cases above illustrate the misinformation that patients sometimes hear and believe, whether that information comes from the web, family, friends, or just long held beliefs about teeth that still exist. It also demonstrates that older adults can often be treated to ideal, while if younger patients miss a window of opportunity with their growth (especially through adolescence), the chance of treating to an ideal result is greatly diminished.

The American Association of Orthodontics recommends that children have an orthodontic exam no later than age 7. Although I feel that the majority of children I see at this age do not need early treatment with braces, many issues that parents need to be aware can be seen by an orthodontist at this age. The most common examples include:

1) Excess crowding (only severe cases need early treatment). Most often mild to moderate crowding can be treated at a later age when all the teeth have erupted. As the first example above demonstrates, this can often be corrected ideally from adolescence through adulthood. As mentioned, severe cases do need early intervention.

2) A lower jaw that is not growing enough, or a upper jaw that is growing too much (what is referred to by the public as an “overbite”) We usually like to wait until the adolescent growth spurt to treat this growth pattern, but if a patient waits too long (like the 20 year old above), the bite often cannot be treated ideally.

3) A lower jaw that is growing too much, or upper not enough (known as an “underbite”). It is extremely important to identify this pattern early, and treatment for this pattern often begins at a very young age. Very severe cases are often not treated at all until a patient is ready for a combination orthodontic/surgical correction. The important thing for these cases is early identification, and to try to avoid the need for surgery if possible.

4) An upper jaw that is too narrow. A narrow maxilla is often the cause of crossbites, and if it causes the lower jaw to shift to one side or contibutes to abnormal eruption of teeth, we will often treat this condition early. Expansion of the upper jaw can accomplished before the the two sides of the maxilla fuse together. This fusion usually occurs earlier for girls (early to mid teens) than in boys (mid teens).

The take home message here is the importance of early identification of issues that may exist, and informing parents of the ideal age to address these issues. Even though the majority of children do not need early treatment, some do and the window for achieving a correction is relatively small. For the others, it is important for parents to know the “game plan” for the future treatment of a child’s individual facial skeletal structure. Just as important is letting parents know when treatment is largely aesthetic in nature, and if there is little concern over an “ideal” age for elective treatment. Always feel free to contact me if you have any questions regarding your child’s teeth or facial growth!

Dr. Dan Rejman is currently the only Board Certified Orthodontist in Castle Rock or Castle Pines, Colorado. He has been a Board Certified Diplomate of the American Board of Orthodontics since 2007.